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Peer-reviewedCC BY-NCJournal of Orthopaedic Case Reports

Cephalomedullary Nailing of Extracapsular Hip Fractures Before and During the COVID-19 Pandemic: A Rural UK Cohort Study

  • Syed Suhaib Jameel1
  • Ronak Naveenchandra Kotian2
  • Hizabr ElHassan3
  • Anoop Pothen John4
  • J S R G Saran5
  • Sameh Hatab6
6 affiliations
  1. 1Department of Orthopaedics, Lower Limb Arthroplasty, Golden Jubilee National Hospital, Glasgow, Scotland, United Kingdom.
  2. 2Department of Orthopaedics, Foot and Ankle Surgery, Golden Jubilee National Hospital, Glasgow, Scotland, United Kingdom.
  3. 3Department of Trauma and Orthopaedics, Dumfries Galloway Royal Infirmary, Dumfries, Scotland, United Kingdom.
  4. 4Department of Orthopaedics, Glangwili General Hospital, Carmarthen, United Kingdom.
  5. 5Department of Orthopaedics, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India.
  6. 6Department of Orthopaedics, Dumfries Galloway Royal Infirmary, Dumfries, Scotland, United Kingdom.
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Abstract

Introduction: The COVID-19 pandemic substantially disrupted orthopedic services, but its effect on fracture patterns and fixation strategies for extracapsular hip fractures remains unclear. This study evaluated whether the pandemic was associated with a change in cephalomedullary nail utilization in a rural UK population. Materials and Methods: A Level III retrospective cohort study was conducted at a rural UK district general hospital. Patients aged ≥50 years with extracapsular hip fractures treated with cephalomedullary nails were compared across two consecutive 24-month periods before (March 2018–March 2020) and during the pandemic (March 2020–March 2022). The primary outcome was the proportion of all hip fractures treated with cephalomedullary nails. Secondary outcomes included operative time, blood loss, reduction method, bisphosphonate use, complications, and 6- and 12-month mortality. Comparisons were unadjusted and used available data without imputation. Results: Among 658 hip fracture admissions, 95 underwent cephalomedullary fixation. Nailing accounted for 13.3% of fractures before and 15.8% during the pandemic (P = 0.36). Operative time increased significantly from 90 to 140 min (P < 0.001). Differences in open reduction, blood loss, bisphosphonate use, complications, and 6 and 12-month mortality were not statistically significant. Conclusion: The COVID-19 pandemic was not associated with a significant change in cephalomedullary nail utilization. However, operative times increased substantially, suggesting persistent effects on surgical efficiency. Given the retrospective, single-center design, modest sample size and incomplete secondary data, these findings are hypothesis-generating, and multicenter studies incorporating fracture classification and risk-adjusted outcomes are warranted.

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Cite

BibTeXRIS
BibTeX
@article{jameel2026cephalomedullary,
  title = {{Cephalomedullary Nailing of Extracapsular Hip Fractures Before and During the COVID-19 Pandemic: A Rural UK Cohort Study}},
  author = {Syed Suhaib Jameel and Ronak Naveenchandra Kotian and Hizabr ElHassan and Anoop Pothen John and J S R G Saran and Sameh Hatab},
  journal = {Journal of Orthopaedic Case Reports},
  year = {2026},
  month = nov,
  doi = {10.13107/jocr.2026.v16.i11.8518},
  url = {https://doi.org/10.13107/jocr.2026.v16.i11.8518},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Cephalomedullary Nailing of Extracapsular Hip Fractures Before and During the COVID-19 Pandemic: A Rural UK Cohort Study
AU  - Syed Suhaib Jameel
AU  - Ronak Naveenchandra Kotian
AU  - Hizabr ElHassan
AU  - Anoop Pothen John
AU  - J S R G Saran
AU  - Sameh Hatab
PY  - 2026
DA  - 2026/11/01
JO  - Journal of Orthopaedic Case Reports
DO  - 10.13107/jocr.2026.v16.i11.8518
UR  - https://doi.org/10.13107/jocr.2026.v16.i11.8518
AB  - Introduction: The COVID-19 pandemic substantially disrupted orthopedic services, but its effect on fracture patterns and fixation strategies for extracapsular hip fractures remains unclear. This study evaluated whether the pandemic was associated with a change in cephalomedullary nail utilization in a rural UK population. Materials and Methods: A Level III retrospective cohort study was conducted at a rural UK district general hospital. Patients aged ≥50 years with extracapsular hip fractures treated with cephalomedullary nails were compared across two consecutive 24-month periods before (March 2018–March 2020) and during the pandemic (March 2020–March 2022). The primary outcome was the proportion of all hip fractures treated with cephalomedullary nails. Secondary outcomes included operative time, blood loss, reduction method, bisphosphonate use, complications, and 6- and 12-month mortality. Comparisons were unadjusted and used available data without imputation. Results: Among 658 hip fracture admissions, 95 underwent cephalomedullary fixation. Nailing accounted for 13.3% of fractures before and 15.8% during the pandemic (P = 0.36). Operative time increased significantly from 90 to 140 min (P < 0.001). Differences in open reduction, blood loss, bisphosphonate use, complications, and 6 and 12-month mortality were not statistically significant. Conclusion: The COVID-19 pandemic was not associated with a significant change in cephalomedullary nail utilization. However, operative times increased substantially, suggesting persistent effects on surgical efficiency. Given the retrospective, single-center design, modest sample size and incomplete secondary data, these findings are hypothesis-generating, and multicenter studies incorporating fracture classification and risk-adjusted outcomes are warranted.
SN  - 2250-0685
SN  - 2321-3817
ER  -